title: Descriptive characteristics and rehabilitation outcomes in active duty military personnel and veterans with disorders of consciousness with combat- and noncombat-related brain injury.
abstract: OBJECTIVE
  To report the injury and demographic characteristics, medical course, and rehabilitation outcome for a consecutive series of veterans and active duty military personnel with combat- and noncombat-related brain injury and disorder of consciousness (DOC) at the time of rehabilitation admission.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Rehabilitation center.
  
  
  METHODS
  From January 2004 to October 2009, persons (N=1654) were admitted to the Polytrauma Rehabilitation System of Care. This study focused on the N=122 persons admitted with a DOC. Participants with a DOC were primarily men (96%), on active duty (82%), ≥12 years of education, and a median age of 25. Brain injury etiologies included mixed blast trauma (24%), penetrating (8%), other trauma (56%), and nontrauma (13%). Median initial Glasgow Coma Scale score was 3, and rehabilitation admission Glasgow Coma Scale score was 8. Individuals were admitted for acute neurorehabilitation approximately 51 days postinjury with a median rehabilitation length of stay of 132 days.
  
  
  METHODS
  None.
  
  
  METHODS
  Recovery of consciousness and the FIM instrument.
  
  
  RESULTS
  Most participants emerged to regain consciousness during neurorehabilitation (64%). Average gains ± SD on the FIM cognitive and motor subscales were 19 ± 25 and 7 ± 8, respectively. Common medical complications included spasticity (70%), dysautonomia (34%), seizure occurrence (30%), and intracranial infection (22%). Differential outcomes were observed across etiologies, particularly for those with blast-related brain injury etiology.
  
  
  CONCLUSIONS
  Despite complex comorbidities, optimistic outcomes were observed. Individuals with severe head injury because of blast-related etiologies have different outcomes and comorbidities observed. Health-services research with a focus on prevention of comorbidities is needed to inform optimal models of care, particularly for combat injured soldiers with blast-related injuries.
authors.affiliation: Mental Health and Behavioral Science Service, James A. Haley Veterans Hospital, Tampa, FL; Department of Psychology, University of South Florida, Tampa, FL; Center of Excellence for Maximizing Rehabilitation Outcomes, Tampa, FL. Electronic address: Risa.Richardson@va.gov.
authors.forename: Risa
authors.initials: R
authors.lastname: Nakase-Richardson
authors.forename: Shane
authors.initials: S
authors.lastname: McNamee
authors.forename: Laura L
authors.initials: LL
authors.lastname: Howe
authors.forename: Jill
authors.initials: J
authors.lastname: Massengale
authors.forename: Michelle
authors.initials: M
authors.lastname: Peterson
authors.forename: Scott D
authors.initials: SD
authors.lastname: Barnett
authors.forename: Odette
authors.initials: O
authors.lastname: Harris
authors.forename: Marissa
authors.initials: M
authors.lastname: McCarthy
authors.forename: Johanna
authors.initials: J
authors.lastname: Tran
authors.forename: Steven
authors.initials: S
authors.lastname: Scott
authors.forename: David X
authors.initials: DX
authors.lastname: Cifu
mesh_terms: D000328:Adult; D001753:Blast Injuries / Q000150:complications; D001930:Brain Injuries / Q000150:complications*; D015897:Comorbidity; D003244:Consciousness Disorders / Q000209:etiology* / Q000534:rehabilitation*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008889:Military Personnel; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States; D014728:Veterans
keywords: Brain injuries; CRS-R; Coma Recovery Scale-Revised; Consciousness disorders; DOC; ECP; Emerging Consciousness Program; Executive function; GCS; GOAT; Galveston Orientation and Amnesia Test; Glasgow Coma Scale; IQR; LCFS; Levels of Cognitive Functioning Scale; O-Log; Orientation Log; Outcome assessment (health care); PRC; PTA; Polytrauma Rehabilitation Center; Rehabilitation; TBI; VA; VHA; Veterans Affairs; Veterans Health Administration; disorder of consciousness; interquartile range; posttraumatic amnesia; traumatic brain injury